| NPI | 1487917381 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: RI 00649) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA4358) |
| Enumeration Date | 2012-06-17 |
| Last Update Date | 2017-05-19 |