| NPI | 1851849574 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: CT 003686) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 003686) |
| 363AS0400X Physician Assistant Surgical (Licence: CT 003686) | |
| Enumeration Date | 2016-09-12 |
| Last Update Date | 2018-10-10 |