| NPI | 1215989959 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: PA MA062550) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: RI PA00299) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2021-07-19 |