| NPI | 1750687612 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NH 1129) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MA PA4089) |
| Enumeration Date | 2011-02-09 |
| Last Update Date | 2015-11-17 |