| NPI | 1639552417 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: NY 028379) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: VA 0110-005000) |
| 363AM0700X Physician Assistant Medical (Licence: CT 23.004799) | |
| 363AS0400X Physician Assistant Surgical (Licence: CT 23.004799) | |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2022-08-05 |