| NPI | 1811538630 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| 363A00000X Physician Assistant (Licence: CT 006165) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| Enumeration Date | 2019-10-02 |
| Last Update Date | 2023-10-30 |