| NPI | 1508464249 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 5607) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CT 5607) |
| 363A00000X Physician Assistant (Licence: CA PA59292) | |
| Enumeration Date | 2020-10-14 |
| Last Update Date | 2022-07-12 |