| NPI | 1194217570 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: CT 4152) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 4152) |
| Enumeration Date | 2018-06-01 |
| Last Update Date | 2021-03-24 |