| NPI | 1508015892 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NY 013524) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 002148) |
| Enumeration Date | 2008-09-11 |
| Last Update Date | 2021-04-15 |