| NPI | 1063526986 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA2493) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 000267) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2014-04-22 |