| NPI | 1053319038 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA1856) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA 1856) |
| 363AM0700X Physician Assistant, Medical (Licence: RI PA00464) | |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2023-02-21 |