| NPI | 1366075871 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA100740) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NH 2844) |
| 363AM0700X Physician Assistant, Medical (Licence: CT 23.004754) | |
| Enumeration Date | 2020-02-13 |
| Last Update Date | 2025-02-28 |