| NPI | 1073964771 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA6424) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: NH 1822) | |
| 363AM0700X Physician Assistant, Medical (Licence: CT 4243) | |
| Enumeration Date | 2016-06-24 |
| Last Update Date | 2023-10-13 |