| NPI | 1679564801 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NH 0658) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VT 055-0030869) |
| Enumeration Date | 2005-11-05 |
| Last Update Date | 2014-08-21 |