| NPI | 1831644855 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 4615) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 020021) |
| Enumeration Date | 2016-08-19 |
| Last Update Date | 2020-01-02 |