| NPI | 1124078449 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 002071) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00138500) |
| 363A00000X Physician Assistant (Licence: NY 009684) | |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2014-08-08 |