| NPI | 1174995245 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AZ 6612) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 019103-1) |
| Enumeration Date | 2015-10-28 |
| Last Update Date | 2022-09-01 |