| NPI | 1649318288 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: MA PA1212) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: MA 1212) |
| 363AM0700X Physician Assistant Medical (Licence: RI PA00663) | |
| Enumeration Date | 2007-02-04 |
| Last Update Date | 2013-11-19 |