| NPI | 1205080496 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA4156) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: RI PA00057-G) |
| Enumeration Date | 2008-11-14 |
| Last Update Date | 2020-11-23 |