NPI | 1578087375 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 4068) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA059185) |
363AS0400X Physician Assistant, Surgical (Licence: CT 4068) | |
Enumeration Date | 2017-08-02 |
Last Update Date | 2025-09-24 |