| NPI | 1528339694 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NY 015326-1) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 015326-1) |
| Enumeration Date | 2012-01-22 |
| Last Update Date | 2012-01-22 |