| NPI | 1942482914 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA2360) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 001992) |
| 363A00000X Physician Assistant (Licence: MA 2360) | |
| Enumeration Date | 2007-12-03 |
| Last Update Date | 2013-01-02 |