| NPI | 1417409806 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9115560) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 020248-1) |
| Enumeration Date | 2016-11-01 |
| Last Update Date | 2025-07-31 |