| NPI | 1669199345 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 5915) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2022-10-24 |
| Last Update Date | 2023-05-15 |