| NPI | 1679259014 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: ME PA2826) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ME PA2826) |
| 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00790300) | |
| Enumeration Date | 2023-06-22 |
| Last Update Date | 2026-01-05 |