| NPI | 1548665219 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: CT 003207) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 003207) |
| 363AM0700X Physician Assistant Medical (Licence: CT 003207) | |
| Enumeration Date | 2014-10-23 |
| Last Update Date | 2020-06-15 |