| NPI | 1235740960 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NY 025536) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA062693) |
| 363AS0400X Physician Assistant, Surgical (Licence: CT 4941) | |
| Enumeration Date | 2020-08-14 |
| Last Update Date | 2023-09-13 |