| NPI | 1689300253 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MA PA102649) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CT 23.005840) |
| Enumeration Date | 2022-07-26 |
| Last Update Date | 2026-06-08 |