| NPI | 1699851568 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 001042) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: CT pending) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2011-04-01 |