| NPI | 1760789234 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TN 3647) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CT 002540) |
| 363AM0700X Physician Assistant, Medical (Licence: NH 1042) | |
| Enumeration Date | 2011-02-18 |
| Last Update Date | 2022-03-16 |