| NPI | 1710926696 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 5034) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 011248) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2022-04-15 |