| NPI | 1720602600 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 4868) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AM0700X Physician Assistant Medical (Licence: CT 4868) | |
| Enumeration Date | 2020-06-05 |
| Last Update Date | 2024-03-27 |