| NPI | 1912158809 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NY 012806) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CT 002178) |
| Enumeration Date | 2008-10-09 |
| Last Update Date | 2011-08-31 |