| NPI | 1376270710 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MA PA9022) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA MSC002611J) |
| 363A00000X Physician Assistant (Licence: CT 5769) | |
| Enumeration Date | 2022-08-05 |
| Last Update Date | 2023-04-06 |