| NPI | 1649425166 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA 2642) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: RI PA00594) |
| Enumeration Date | 2008-11-25 |
| Last Update Date | 2021-06-01 |