| NPI | 1407232390 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: NY 019955) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: CT 003357) |
| Enumeration Date | 2015-08-03 |
| Last Update Date | 2017-11-03 |