| NPI | 1114595790 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ME PA2436) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 124500081206) |
| Enumeration Date | 2021-06-11 |
| Last Update Date | 2022-11-08 |