| NPI | 1295106763 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NY 026658) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 6161) |
| 363A00000X Physician Assistant (Licence: MN 12313) | |
| Enumeration Date | 2015-10-09 |
| Last Update Date | 2021-10-07 |