| NPI | 1871589150 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: VT 0550030657) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: VT 0550030657) |
| 363A00000X Physician Assistant (Licence: NY 010999) | |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2013-06-28 |