| NPI | 1235492331 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 015654) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 015654) |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2019-10-17 |