| NPI | 1548898042 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 4889) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CT 4889) |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2021-05-13 |