| NPI | 1790014058 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MA PA4178) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: RI PA00537) |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 012748) | |
| Enumeration Date | 2009-12-16 |
| Last Update Date | 2024-06-03 |