| NPI | 1043273998 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.006254RX) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: ME AT341) |
| 363A00000X Physician Assistant (Licence: ME PA1702) | |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2020-02-26 |