| NPI | 1467703421 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C06243) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 015857) |
| 363AS0400X Physician Assistant, Surgical (Licence: MD C0006243) | |
| Enumeration Date | 2012-09-30 |
| Last Update Date | 2021-03-11 |