| NPI | 1194978908 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NY 012769-1) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 10982) |
| 363A00000X Physician Assistant (Licence: NJ MP00263400) | |
| Enumeration Date | 2008-10-24 |
| Last Update Date | 2015-09-11 |