| NPI | 1730166703 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9104048) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ME PA462) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2017-08-23 |