| NPI | 1629506092 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 3870) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2017-05-30 |
| Last Update Date | 2019-10-02 |