NPI | 1316520489 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: ME PA2741) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: ME PA2741) |
363A00000X Physician Assistant (Licence: NH 1930) | |
Enumeration Date | 2021-05-05 |
Last Update Date | 2025-03-06 |