| NPI | 1205187283 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 3031) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 016001) |
| Enumeration Date | 2012-10-01 |
| Last Update Date | 2019-02-22 |