| NPI | 1962742379 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA5782) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 016389) |
| 363A00000X Physician Assistant (Licence: CT 6012) | |
| Enumeration Date | 2013-02-21 |
| Last Update Date | 2024-11-25 |