| NPI | 1023216850 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 002728) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 011881) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2021-10-19 |