| NPI | 1194117705 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 4331) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AS0400X Physician Assistant Surgical (Licence: NY 018492) | |
| Enumeration Date | 2015-02-19 |
| Last Update Date | 2022-07-23 |