| NPI | 1578059200 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ME PA2688) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 025263) |
| 363A00000X Physician Assistant (Licence: VT 055.0031692) | |
| Enumeration Date | 2018-07-05 |
| Last Update Date | 2025-02-24 |