| NPI | 1881677219 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9108623) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9108623) |
| 363A00000X Physician Assistant (Licence: NY 010946) | |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2019-09-03 |