| NPI | 1730626490 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 4040) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0006353) |
| Enumeration Date | 2017-01-19 |
| Last Update Date | 2021-09-14 |