| NPI | 1639610496 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 4240) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 2050) |
| Enumeration Date | 2017-03-13 |
| Last Update Date | 2018-09-19 |