| NPI | 1316466998 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 4777) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.005231RX) |
| Enumeration Date | 2017-09-14 |
| Last Update Date | 2020-10-15 |