| NPI | 1861626632 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL 9109430) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 013207) |
| Enumeration Date | 2009-05-08 |
| Last Update Date | 2022-01-18 |