| NPI | 1558369512 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: RI PA00518) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NV PA1065) |
| 363AM0700X Physician Assistant Medical (Licence: OH 50001173) | |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2020-01-29 |