| NPI | 1487278677 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: 1162745) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 1162745) |
| Enumeration Date | 2020-06-03 |
| Last Update Date | 2020-06-03 |