| NPI | 1578041745 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: CT 004287) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: CT 004287) |
| 363A00000X Physician Assistant (Licence: CT 004287) | |
| Enumeration Date | 2018-07-31 |
| Last Update Date | 2021-11-09 |