| NPI | 1699962167 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: NY 010445) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NY 010455) |
| Enumeration Date | 2007-09-28 |
| Last Update Date | 2023-11-27 |