| NPI | 1225268857 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 002498) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MA PA3792) |
| Enumeration Date | 2009-07-16 |
| Last Update Date | 2011-02-04 |