| NPI | 1194024299 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NH 1079) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9105797) |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 014676) | |
| Enumeration Date | 2011-03-15 |
| Last Update Date | 2016-11-15 |