| NPI | 1174633630 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ME PA1469) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA10004717) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2023-11-13 |