| NPI | 1205204435 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 6390) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 55519) |
| 363A00000X Physician Assistant (Licence: NY 019134) | |
| Enumeration Date | 2015-09-03 |
| Last Update Date | 2024-02-02 |