| NPI | 1063975381 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 4455) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 023453-1) |
| Enumeration Date | 2019-04-12 |
| Last Update Date | 2025-01-09 |