| NPI | 1124221858 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 1769) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 001763) |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2020-04-27 |