| NPI | 1538697123 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: RI PA01602) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9110373) |
| Enumeration Date | 2017-05-26 |
| Last Update Date | 2023-07-10 |