| NPI | 1700874690 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: RI PA00189) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA00189) |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2020-09-15 |