| NPI | 1861642159 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9107884) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA MA053542) |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 014089) | |
| Enumeration Date | 2008-09-24 |
| Last Update Date | 2020-12-04 |