| NPI | 1356512800 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 002074) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 017549) |
| 363A00000X Physician Assistant (Licence: MA PA5046) | |
| Enumeration Date | 2008-03-12 |
| Last Update Date | 2022-07-21 |