| NPI | 1629095641 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA 192510) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: RI PA00320) |
| 363A00000X Physician Assistant (Licence: CT 001043) | |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2019-12-17 |