| NPI | 1730153800 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: WI 2107) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: ME PA1042) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2013-07-15 |