| NPI | 1255525556 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: RI PA00669) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 001907) |
| 363AS0400X Physician Assistant Surgical (Licence: NY 09166) | |
| Enumeration Date | 2007-08-29 |
| Last Update Date | 2022-09-12 |