| NPI | 1679897615 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VT 055.0031211) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: PA MA054137) |
| Enumeration Date | 2010-03-19 |
| Last Update Date | 2016-06-06 |