| NPI | 1215312962 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 004213) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA5465) |
| Enumeration Date | 2015-07-23 |
| Last Update Date | 2022-09-12 |