| NPI | 1083217855 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: CT 4963) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical |
| Enumeration Date | 2020-11-16 |
| Last Update Date | 2022-01-07 |