| NPI | 1083138267 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA100379) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: VT 074.0132106) |
| Enumeration Date | 2017-07-31 |
| Last Update Date | 2024-03-25 |