| NPI | 1962743872 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MA PA4655) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 003422) |
| Enumeration Date | 2013-03-04 |
| Last Update Date | 2015-09-16 |