| NPI | 1811362981 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA 54148) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 018818) |
| Enumeration Date | 2015-12-01 |
| Last Update Date | 2022-02-11 |