| NPI | 1215289822 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 3538) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 3538) |
| 363AM0700X Physician Assistant, Medical (Licence: CT 3538) | |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 016013-1) | |
| Enumeration Date | 2012-10-05 |
| Last Update Date | 2019-09-12 |