| NPI | 1679754238 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 4965) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 012301) |
| Enumeration Date | 2007-11-23 |
| Last Update Date | 2020-08-26 |