| NPI | 1770121162 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 5192) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MA 7988) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-12-16 |
| Last Update Date | 2023-03-10 |