| NPI | 1730285982 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 001342) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 5606) |
| 363A00000X Physician Assistant (Licence: ME PA646) | |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2022-11-08 |