| NPI | 1801297437 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 3183) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA5136) |
| Enumeration Date | 2014-09-15 |
| Last Update Date | 2020-01-10 |