| NPI | 1760731715 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 002881) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA4425) |
| 363A00000X Physician Assistant (Licence: CT 002881) | |
| 363AM0700X Physician Assistant, Medical (Licence: CT 002881) | |
| Enumeration Date | 2012-09-06 |
| Last Update Date | 2017-02-17 |