| NPI | 1821419862 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA 4904) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 3002) |
| Enumeration Date | 2013-12-18 |
| Last Update Date | 2018-11-08 |