| NPI | 1811499130 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA6415) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 4044) |
| Enumeration Date | 2018-03-02 |
| Last Update Date | 2022-01-28 |