| NPI | 1679122725 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 5024) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 1168557) |
| 363A00000X Physician Assistant | |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 024193) | |
| Enumeration Date | 2019-09-10 |
| Last Update Date | 2024-10-31 |