| NPI | 1366476400 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VT 55-0030650) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 026780) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2021-12-20 |