| NPI | 1609428754 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 4526) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: 0000) |
| Enumeration Date | 2019-07-09 |
| Last Update Date | 2019-09-17 |