| NPI | 1912495797 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 4248) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA6403) |
| 363AM0700X Physician Assistant, Medical (Licence: CT 004248) | |
| Enumeration Date | 2018-04-26 |
| Last Update Date | 2021-11-08 |