| NPI | 1588206049 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA7274) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ME PAN1997) |
| Enumeration Date | 2019-10-16 |
| Last Update Date | 2022-03-09 |