| NPI | 1811992076 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 2425) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA 1886) |
| 363AS0400X Physician Assistant, Surgical (Licence: RI 00383) | |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2010-09-15 |