| NPI | 1659864551 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 4169) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-10141) |
| Enumeration Date | 2018-06-14 |
| Last Update Date | 2021-06-23 |