| NPI | 1992979322 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: NY 009757) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NY 009757) |
| 363AS0400X Physician Assistant Surgical (Licence: NJ 25MP0012890) | |
| Enumeration Date | 2008-04-16 |
| Last Update Date | 2014-06-09 |