| NPI | 1154321842 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: VT 0550030631) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 011444) |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2013-06-07 |