| NPI | 1083892640 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 003367) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA 2476) |
| Enumeration Date | 2008-02-06 |
| Last Update Date | 2015-09-21 |