| NPI | 1063470557 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VT 055.0031114) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA 586) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2014-12-15 |