| NPI | 1376867176 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA4552) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: RI PA00535) |
| Enumeration Date | 2010-03-23 |
| Last Update Date | 2024-06-03 |