| NPI | 1962008441 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA100605) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 5098) |
| 363AM0700X Physician Assistant, Medical (Licence: CT 005098) | |
| Enumeration Date | 2020-12-09 |
| Last Update Date | 2024-10-07 |