| NPI | 1598244030 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9112299) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 022444) |
| Enumeration Date | 2018-08-07 |
| Last Update Date | 2021-05-18 |