| NPI | 1578087375 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 4068) | 
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA059185) | 
| 363AS0400X Physician Assistant, Surgical (Licence: CT 4068) | |
| Enumeration Date | 2017-08-02 | 
| Last Update Date | 2025-09-24 |