| NPI | 1275968075 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 003774) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA4821) |
| 363AM0700X Physician Assistant, Medical (Licence: MA PA) | |
| 363AS0400X Physician Assistant, Surgical (Licence: MA PA4821) | |
| Enumeration Date | 2013-09-11 |
| Last Update Date | 2022-09-20 |