| NPI | 1861896524 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 4051) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MA 5169) |
| Enumeration Date | 2014-10-09 |
| Last Update Date | 2019-05-22 |