| NPI | 1619421518 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 003636) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 020333) |
| Enumeration Date | 2016-08-09 |
| Last Update Date | 2024-05-06 |