| NPI | 1124889142 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA100420) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 7406) |
| Enumeration Date | 2024-01-17 |
| Last Update Date | 2025-12-15 |