| NPI | 1114309788 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA5382) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: RI PA00810) |
| Enumeration Date | 2015-06-19 |
| Last Update Date | 2015-06-19 |