| NPI | 1508991704 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: NY 011065) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110002555) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2011-05-27 |