| NPI | 1063513950 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA4939) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: VT 0550030196) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2025-03-15 |