| NPI | 1063142982 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 005754) |
| Additional Taxonomies | 2086S0129X (Licence: CT 23) |
| Enumeration Date | 2022-06-14 |
| Last Update Date | 2022-08-30 |