| NPI | 1912408337 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 4092) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA6456) |
| Enumeration Date | 2018-02-21 |
| Last Update Date | 2018-06-18 |