| NPI | 1821049206 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: CT 001633) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NY 012904) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2023-03-07 |