| NPI | 1508400268 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA063123) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 4699) |
| Enumeration Date | 2019-11-05 |
| Last Update Date | 2024-02-01 |