| NPI | 1104147701 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MA PA3970) |
| 363AM0700X Physician Assistant, Medical (Licence: NH 0931) | |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2022-01-28 |