| NPI | 1790914596 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 2577) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MA 1404) |
| 363AM0700X Physician Assistant, Medical (Licence: CT 2577) | |
| Enumeration Date | 2009-07-14 |
| Last Update Date | 2015-11-17 |