| NPI | 1457701518 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 12335053-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: RI PA00888) |
| Enumeration Date | 2016-06-20 |
| Last Update Date | 2021-08-20 |