| NPI | 1144472804 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-05403) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 23 012890) |
| Enumeration Date | 2008-10-14 |
| Last Update Date | 2017-04-17 |