| NPI | 1659456630 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ME PA1497) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL 9108417) |
| 363AS0400X Physician Assistant, Surgical (Licence: MA 800) | |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2020-11-06 |