| NPI | 1083951289 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 4571) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 016178) |
| Enumeration Date | 2013-01-08 |
| Last Update Date | 2020-05-05 |