| NPI | 1083003115 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 4098) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA09592) |
| Enumeration Date | 2015-01-13 |
| Last Update Date | 2019-05-24 |