| NPI | 1235686098 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 5605) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-06542) |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 028282) | |
| Enumeration Date | 2016-09-08 |
| Last Update Date | 2022-04-26 |