| NPI | 1588089213 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA4860) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: RI PA00745) |
| Enumeration Date | 2014-03-05 |
| Last Update Date | 2019-07-25 |