| NPI | 1962062810 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 4623) |
| Additional Taxonomies | 208800000X Urology (Licence: CT pending) |
| Enumeration Date | 2019-06-13 |
| Last Update Date | 2020-03-16 |