| NPI | 1760011043 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 5077) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 5077) |
| Enumeration Date | 2020-04-07 |
| Last Update Date | 2021-02-08 |