| NPI | 1811369895 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 4093) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 018809) |
| Enumeration Date | 2015-10-29 |
| Last Update Date | 2018-06-11 |