NPI | 1376103812 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 4561) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CT 4561) |
Enumeration Date | 2019-06-17 |
Last Update Date | 2022-09-18 |