| NPI | 1538434634 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: RI PA00355) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9104886) |
| 363AM0700X Physician Assistant, Medical (Licence: MA PA2097) | |
| Enumeration Date | 2012-03-21 |
| Last Update Date | 2019-03-12 |