| NPI | 1619164985 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 1976) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 001976) |
| 363A00000X Physician Assistant (Licence: NC 0010-01451) | |
| Enumeration Date | 2007-10-01 |
| Last Update Date | 2018-05-24 |