| NPI | 1912244559 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: MD C09169) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 016137) |
| 363AS0400X Physician Assistant Surgical (Licence: NY 016137) | |
| Enumeration Date | 2013-01-15 |
| Last Update Date | 2024-02-26 |