| NPI | 1417303496 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110006870) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 019627-1) |
| Enumeration Date | 2016-05-10 |
| Last Update Date | 2020-09-22 |