| NPI | 1194104000 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AZ 6075) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 018659) |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2022-01-11 |