| NPI | 1366561318 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA058017) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 010699) |
| 363A00000X Physician Assistant (Licence: SC 2008) | |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2016-06-22 |