| NPI | 1871132506 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 026213) |
| Enumeration Date | 2019-12-28 |
| Last Update Date | 2021-12-07 |