| NPI | 1598765711 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 001072) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA1264) |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2013-06-28 |