| NPI | 1861755050 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110004128) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 2261) |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2025-01-17 |