| NPI | 1730710690 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NY 024619) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10003996A) |
| 363A00000X Physician Assistant (Licence: VT 055-0031733) | |
| Enumeration Date | 2020-01-30 |
| Last Update Date | 2024-01-25 |