| NPI | 1730567611 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 3299) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 003299) |
| 363A00000X Physician Assistant (Licence: MD C5760) | |
| 363A00000X Physician Assistant (Licence: MD C00A5760) | |
| Enumeration Date | 2015-05-12 |
| Last Update Date | 2024-06-24 |