| NPI | 1992705834 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 001564) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA101515) |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2025-06-03 |