| NPI | 1922564335 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: ME PA1920) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110-006514) |
| Enumeration Date | 2019-02-11 |
| Last Update Date | 2021-03-03 |