| NPI | 1104819341 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: RI PA00380) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA101298) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2025-06-10 |