| NPI | 1619117017 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NY 011534) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 011534) |
| Enumeration Date | 2009-02-24 |
| Last Update Date | 2019-01-08 |