| NPI | 1811410053 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VT 055.0031359) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA6261) |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2018-04-30 |