| NPI | 1215245543 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA4044) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 3421) |
| Enumeration Date | 2010-09-21 |
| Last Update Date | 2015-10-20 |