| NPI | 1326390030 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 002779) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MA PA4539) |
| Enumeration Date | 2012-10-04 |
| Last Update Date | 2014-07-11 |