| NPI | 1316476633 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 4680) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA 1138621) |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2020-01-06 |