| NPI | 1407408735 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MA PA8058) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 023651) |
| Enumeration Date | 2019-07-16 |
| Last Update Date | 2024-04-05 |