| NPI | 1265420061 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 014910) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 025130) |
| 363A00000X Physician Assistant (Licence: CT 2947) | |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2021-04-01 |