| NPI | 1871212332 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 005925) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2022-08-26 |
| Last Update Date | 2022-12-11 |