| NPI | 1316202641 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: CT 3062) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA4450) |
| 363AS0400X Physician Assistant Surgical (Licence: CT 3062) | |
| 363A00000X Physician Assistant (Licence: CT 3062) | |
| Enumeration Date | 2012-07-12 |
| Last Update Date | 2015-12-03 |