| NPI | 1639454960 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA4578) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 2665) |
| 363AS0400X Physician Assistant Surgical (Licence: CT 2665) | |
| Enumeration Date | 2011-10-18 |
| Last Update Date | 2020-10-23 |