| NPI | 1699963405 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 001987) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: DE 001987) |
| Enumeration Date | 2007-10-05 |
| Last Update Date | 2007-10-05 |