| NPI | 1164476164 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AK AK618) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VT 055-0031086) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2011-06-27 |