| NPI | 1811917495 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AM0700X Physician Assistant Medical (Licence: NY 011264) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2021-05-21 |