| NPI | 1053756288 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 003075) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CT 003075) |
| 363AS0400X Physician Assistant, Surgical (Licence: CT 003075) | |
| 363A00000X Physician Assistant (Licence: NC 0010-04193) | |
| Enumeration Date | 2013-05-01 |
| Last Update Date | 2014-05-09 |