| NPI | 1629200969 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MA PA5024) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: RI PA00515) |
| Enumeration Date | 2009-08-20 |
| Last Update Date | 2015-12-14 |