| NPI | 1083657985 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME139358) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 139358) |
| 208D00000X General Practice (Licence: MD D0084552) | |
| 363A00000X Physician Assistant (Licence: NM PA 2013-0049) | |
| 363A00000X Physician Assistant (Licence: FL PA9101741) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2019-11-15 |