| NPI | 1780962514 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 3415) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 014951) |
| Enumeration Date | 2011-07-27 |
| Last Update Date | 2015-12-09 |