| NPI | 1649555012 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AZ 8904) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 015219) |
| Enumeration Date | 2011-10-18 |
| Last Update Date | 2024-04-05 |