| NPI | 1891331591 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 6710) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 6170) |
| 363A00000X Physician Assistant (Licence: NY 026558) | |
| Enumeration Date | 2019-11-18 |
| Last Update Date | 2023-11-28 |