| NPI | 1871590661 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AZ 1339) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 002551) |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 002551) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2022-03-08 |