| NPI | 1225101082 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: CA 21492) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NY 010814-1) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2011-11-15 |