| NPI | 1427191667 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-03722) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-03722) |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 013063) | |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2019-09-26 |