| NPI | 1093772519 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA 721) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NH 0150) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2013-06-10 |