| NPI | 1184637654 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 6908) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA17769) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2025-05-12 |