| NPI | 1265981641 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 4618) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX 655094) |
| Enumeration Date | 2016-09-27 |
| Last Update Date | 2022-10-24 |