| NPI | 1992031124 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 013532) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VT 055-0031522) |
| 363AS0400X Physician Assistant Surgical (Licence: MD C0004445) | |
| Enumeration Date | 2009-10-22 |
| Last Update Date | 2021-11-08 |