| NPI | 1578128484 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 4472) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 5368) |
| Enumeration Date | 2019-05-06 |
| Last Update Date | 2026-03-23 |