| NPI | 1205857000 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 001474) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MA 1299) |
| 363AM0700X Physician Assistant, Medical (Licence: MA PA1299) | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2010-02-16 |