| NPI | 1922479112 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 019219-1) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WI 4575-23) |
| Enumeration Date | 2015-10-13 |
| Last Update Date | 2020-01-13 |