| NPI | 1003195785 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 002622) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical |
| 207Q00000X Family Medicine (Licence: CT 002622) | |
| Enumeration Date | 2011-08-11 |
| Last Update Date | 2014-07-16 |