| NPI | 1861792368 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA054526) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 014344-1) |
| 363AM0700X Physician Assistant, Medical (Licence: PA OA002576) | |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2010-10-30 |
| Last Update Date | 2023-06-02 |