| NPI | 1992829964 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 6125965-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ME PA001262) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2012-03-14 |