| NPI | 1194246512 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ME PA1919) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA6145) |
| Enumeration Date | 2017-07-06 |
| Last Update Date | 2019-08-08 |