| NPI | 1174835292 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 4706) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ME PA001223) |
| Enumeration Date | 2010-07-06 |
| Last Update Date | 2020-08-10 |