| NPI | 1437349362 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VT 055-0030960) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00183000) |
| 261QU0200X Clinic/Center, Urgent Care (Licence: VT 055-0030960) | |
| Enumeration Date | 2007-07-26 |
| Last Update Date | 2013-10-03 |