| NPI | 1124748413 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AZ 9202) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 028735) |
| Enumeration Date | 2022-08-29 |
| Last Update Date | 2023-08-09 |