| NPI | 1871560821 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ME PA1601) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00160900) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2016-07-07 |