| NPI | 1093145351 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 3045) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 3045) |
| 363AM0700X Physician Assistant, Medical (Licence: NY 017137) | |
| Enumeration Date | 2013-11-22 |
| Last Update Date | 2019-07-15 |