| NPI | 1588210629 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 004707) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA9374) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2019-08-14 |
| Last Update Date | 2023-05-12 |