| NPI | 1386859890 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VT 0550030813) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: VT 0550030813) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2008-02-01 |