| NPI | 1780726232 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: VT 055-0030921) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NY 011732) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2011-12-20 |