| NPI | 1922005917 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: CT 000869) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 000869) |
| 363AS0400X Physician Assistant Surgical (Licence: MA PA1056) | |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2020-07-02 |