| NPI | 1366525826 |
|---|---|
| Former Name | LISA MARIE GOURLEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ME PA1830) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0003392) |
| 363AM0700X Physician Assistant, Medical (Licence: MD C0003392) | |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2023-11-14 |