| NPI | 1477553600 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL 9112783) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 000280) |
| 363AM0700X Physician Assistant, Medical (Licence: CT 000280) | |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2021-12-13 |