| NPI | 1962476218 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA304) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 001199) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2021-10-20 |