| NPI | 1699882373 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: ME PA1433) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ME PA1433) |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 0098561) | |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2019-04-01 |