| NPI | 1164804183 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA7345) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VT 055-0031706) |
| 363A00000X Physician Assistant (Licence: WA PA60705903) | |
| Enumeration Date | 2015-06-25 |
| Last Update Date | 2023-11-02 |