| NPI | 1801245006 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 4594) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 019693) |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2019-09-18 |