| NPI | 1104415884 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: RI PA01317) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA8097) |
| Enumeration Date | 2021-01-15 |
| Last Update Date | 2026-06-01 |