| NPI | 1164671707 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 012785) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 012785) |
| Enumeration Date | 2008-09-18 |
| Last Update Date | 2016-08-03 |