| NPI | 1609326552 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MA PA5951) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CT 3673) |
| 363AS0400X Physician Assistant, Surgical (Licence: NH 1433) | |
| Enumeration Date | 2016-10-04 |
| Last Update Date | 2019-10-09 |