| NPI | 1063415313 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: VT 0555.0031656) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 3136) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2023-08-16 |