| NPI | 1679993539 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 3065) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 003065) |
| Enumeration Date | 2014-04-18 |
| Last Update Date | 2019-09-16 |