| NPI | 1568790806 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: ME PA1337) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MAO54233) |
| Enumeration Date | 2009-11-25 |
| Last Update Date | 2012-05-09 |