| NPI | 1568847556 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 5450) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA5472) |
| Enumeration Date | 2015-07-20 |
| Last Update Date | 2022-03-31 |