| NPI | 1811547508 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 4642) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CT 4642) |
| Enumeration Date | 2019-09-16 |
| Last Update Date | 2023-01-07 |