| NPI | 1760493100 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: NH 0163) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: VT 0550030216) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2010-05-24 |