| NPI | 1003453556 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 6124) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NH 1698) |
| Enumeration Date | 2019-12-03 |
| Last Update Date | 2023-07-10 |