| NPI | 1033775697 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 004640) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA7086) |
| Enumeration Date | 2019-05-18 |
| Last Update Date | 2021-12-09 |