| NPI | 1972855971 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NY 015998) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9110522) |
| 363A00000X Physician Assistant (Licence: NY 015998) | |
| Enumeration Date | 2012-10-15 |
| Last Update Date | 2023-12-07 |