NPI | 1215331145 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 4757) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 018060) |
Enumeration Date | 2014-10-21 |
Last Update Date | 2024-07-16 |