| NPI | 1902144157 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 4047) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 016251-1) |
| Enumeration Date | 2013-01-23 |
| Last Update Date | 2019-06-24 |