| NPI | 1174910194 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 4383) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: 1088242) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2015-04-16 |
| Last Update Date | 2019-02-05 |