| NPI | 1508908542 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA2301) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 001245) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2019-01-07 |