| NPI | 1962818013 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 4118) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 002025-1) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2022-07-21 |