| NPI | 1245006147 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 6374) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 031018) |
| Enumeration Date | 2023-11-30 |
| Last Update Date | 2023-11-30 |