| NPI | 1366795759 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA4551) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ME PA1567) |
| Enumeration Date | 2012-10-22 |
| Last Update Date | 2020-11-02 |