| NPI | 1780219600 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CT 5536) |
| Enumeration Date | 2020-03-11 |
| Last Update Date | 2022-02-07 |