| NPI | 1174143416 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA7505) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CT 4818) |
| Enumeration Date | 2020-04-16 |
| Last Update Date | 2022-04-22 |