| NPI | 1790250090 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NH 1893) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA6793) |
| 363AM0700X Physician Assistant, Medical (Licence: CT 4504) | |
| Enumeration Date | 2018-10-12 |
| Last Update Date | 2022-08-17 |