| NPI | 1306213459 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 4030) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA5471) |
| Enumeration Date | 2015-08-25 |
| Last Update Date | 2018-03-26 |