| NPI | 1629215553 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: CT 2229) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2009-01-14 |
| Last Update Date | 2015-11-20 |