| NPI | 1326012345 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA3975) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: RI PA00367) |
| 363AM0700X Physician Assistant Medical (Licence: MA PA3975) | |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2020-11-02 |