| NPI | 1396254348 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 5564) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 021364) |
| Enumeration Date | 2017-09-21 |
| Last Update Date | 2022-07-20 |