| NPI | 1508175878 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: GA 9613) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: NY 0142331) |
| Enumeration Date | 2010-10-04 |
| Last Update Date | 2020-05-22 |