| NPI | 1659036333 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VT 055.0031592) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 4198) |
| Enumeration Date | 2021-11-08 |
| Last Update Date | 2022-10-13 |