| NPI | 1194070466 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 5643) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 015768) |
| 363AM0700X Physician Assistant, Medical (Licence: NH 1660) | |
| Enumeration Date | 2012-07-23 |
| Last Update Date | 2022-06-27 |