| NPI | 1760001531 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VT 055.0031792) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 4794) |
| Enumeration Date | 2020-04-13 |
| Last Update Date | 2025-08-05 |