| NPI | 1639629892 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: RI PA00949) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MA PA5845) |
| Enumeration Date | 2016-10-11 |
| Last Update Date | 2018-07-25 |