| NPI | 1962629857 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA3945) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ME PA001086) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2011-11-01 |