| NPI | 1083880850 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 3722) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 004830) |
| Enumeration Date | 2008-05-01 |
| Last Update Date | 2021-07-26 |