| NPI | 1972769578 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 012605) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 012605-1) |
| Enumeration Date | 2008-08-03 |
| Last Update Date | 2015-06-04 |