| NPI | 1255783262 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 5674) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DE C5-0001073) |
| 363A00000X Physician Assistant (Licence: NY 019766-1) | |
| Enumeration Date | 2016-07-01 |
| Last Update Date | 2023-11-20 |