| NPI | 1760490809 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 001036) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA 2647) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2025-12-17 |