| NPI | 1073921847 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MA PA5087) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CT 23.003123) |
| Enumeration Date | 2014-07-24 |
| Last Update Date | 2021-01-13 |