| NPI | 1942789557 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ME PA1845) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00488100) |
| Enumeration Date | 2018-08-14 |
| Last Update Date | 2019-03-09 |