| NPI | 1992249163 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: CT 004711) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: CA 54060) |
| 363A00000X Physician Assistant (Licence: CT 4711) | |
| Enumeration Date | 2016-12-07 |
| Last Update Date | 2021-08-12 |