| NPI | 1366096869 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 5158) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 001009288) |
| 363AM0700X Physician Assistant, Medical (Licence: FL 9112337) | |
| Enumeration Date | 2019-08-01 |
| Last Update Date | 2022-10-21 |