| NPI | 1407257058 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MD C07103) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9110354) |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 017923) | |
| Enumeration Date | 2014-09-12 |
| Last Update Date | 2020-02-21 |