| NPI | 1679712053 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 4369) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA2591) |
| 363AS0400X Physician Assistant, Surgical (Licence: RI PA00482) | |
| Enumeration Date | 2009-02-09 |
| Last Update Date | 2024-04-30 |