| NPI | 1790239424 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VT 055-0031653) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA5807) |
| Enumeration Date | 2016-08-10 |
| Last Update Date | 2023-04-25 |