| NPI | 1578059200 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VT 055.0031692) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 025263) |
| Enumeration Date | 2018-07-05 |
| Last Update Date | 2023-10-10 |