| NPI | 1639588502 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 3168) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 3168) |
| Enumeration Date | 2014-08-05 |
| Last Update Date | 2018-04-11 |