| NPI | 1700228129 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 4620) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA08521) |
| 363A00000X Physician Assistant (Licence: NY 025830) | |
| 363AS0400X Physician Assistant, Surgical (Licence: TX PA08521) | |
| Enumeration Date | 2013-07-26 |
| Last Update Date | 2021-05-05 |