| NPI | 1538540257 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: CT 3360) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical |
| Enumeration Date | 2015-06-18 |
| Last Update Date | 2020-01-29 |