| NPI | 1194073049 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 002801) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 015868) |
| Enumeration Date | 2012-08-27 |
| Last Update Date | 2020-05-08 |