| NPI | 1962726992 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA053793) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: ME PA1784) |
| Enumeration Date | 2010-03-19 |
| Last Update Date | 2018-05-02 |