| NPI | 1215324355 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 5375) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NH 1085) |
| Enumeration Date | 2015-04-15 |
| Last Update Date | 2021-09-08 |