| NPI | 1790403855 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 6527) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OH 000692771) |
| Enumeration Date | 2022-08-16 |
| Last Update Date | 2024-04-22 |