| NPI | 1215002738 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MA PA2188) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CT 002394) |
| 363AM0700X Physician Assistant, Medical (Licence: MA 2188) | |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2021-02-19 |