| NPI | 1538623053 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NY 023209) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 023209) |
| Enumeration Date | 2019-01-29 |
| Last Update Date | 2022-04-18 |