| NPI | 1205307527 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 5112) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 023459) |
| 363AM0700X Physician Assistant, Medical (Licence: PA MA060399) | |
| Enumeration Date | 2018-12-14 |
| Last Update Date | 2021-01-29 |