| NPI | 1962026229 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 004855) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 027729) |
| 363AM0700X Physician Assistant, Medical (Licence: NY 027729) | |
| Enumeration Date | 2020-06-02 |
| Last Update Date | 2021-11-21 |