| NPI | 1831649300 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 23020217) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CT 3706) |
| Enumeration Date | 2016-10-10 |
| Last Update Date | 2022-08-11 |