| NPI | 1972116978 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 5130) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: 1162774) |
| 363A00000X Physician Assistant (Licence: NY 026344) | |
| Enumeration Date | 2020-08-28 |
| Last Update Date | 2022-10-14 |