| NPI | 1972794188 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NY 012882-1) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA 2358) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2021-05-04 |