| NPI | 1770900086 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MA PA5976) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CT 4374) |
| Enumeration Date | 2014-03-25 |
| Last Update Date | 2020-01-30 |