| NPI | 1629367537 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: RI 587) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: RI PA00587) |
| 363AS0400X Physician Assistant, Surgical (Licence: MA PA5075) | |
| Enumeration Date | 2011-03-31 |
| Last Update Date | 2016-01-29 |