| NPI | 1528215506 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ME PA1700) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-01454) |
| 363AM0700X Physician Assistant, Medical (Licence: NC 0010-01454) | |
| Enumeration Date | 2008-08-21 |
| Last Update Date | 2019-11-22 |