| NPI | 1770677338 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: VT 055.0031182) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NH 0600) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2013-09-12 |