| NPI | 1508042664 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: CT 548) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: NY 005445) |
| Enumeration Date | 2008-01-18 |
| Last Update Date | 2025-09-04 |