| NPI | 1730453663 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA4406) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 002725) |
| Enumeration Date | 2012-02-23 |
| Last Update Date | 2013-12-12 |