| NPI | 1194020891 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: ME PA1564) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA161551) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: n/a) | |
| Enumeration Date | 2011-01-11 |
| Last Update Date | 2018-09-26 |