| NPI | 1639400138 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA3933) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CT 002973) |
| Enumeration Date | 2010-01-22 |
| Last Update Date | 2015-08-14 |