| NPI | 1801107446 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA4503) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ME PA-266) |
| Enumeration Date | 2010-06-29 |
| Last Update Date | 2012-12-18 |