| NPI | 1780082719 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WV 2161) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: VT 055.0031229) |
| Enumeration Date | 2014-12-08 |
| Last Update Date | 2018-06-28 |