| NPI | 1306296470 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 3423) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 23 019198) |
| Enumeration Date | 2016-06-20 |
| Last Update Date | 2022-01-13 |