| NPI | 1578087375 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: CT 4068) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: PA MA059185) |
| Enumeration Date | 2017-08-02 |
| Last Update Date | 2022-11-18 |