| NPI | 1174801278 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 4053) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CT 002612) |
| 363AM0700X Physician Assistant, Medical (Licence: NH 1023) | |
| Enumeration Date | 2011-07-25 |
| Last Update Date | 2024-07-16 |