| NPI | 1780158501 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: NY 005017) |
| Enumeration Date | 2019-01-15 |
| Last Update Date | 2022-04-18 |