| NPI | 1194844704 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 009439) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 3618) |
| 363AS0400X Physician Assistant Surgical (Licence: AZ 003618) | |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2023-03-07 |