| NPI | 1083395958 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 23.007622) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA100052) |
| Enumeration Date | 2023-07-25 |
| Last Update Date | 2026-05-29 |