| NPI | 1649818634 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 4713) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-09478) |
| Enumeration Date | 2019-12-20 |
| Last Update Date | 2020-02-10 |