NPI | 1710238308 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA8670) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL 9106820) |
363A00000X Physician Assistant (Licence: RI PA01203) | |
Enumeration Date | 2012-09-24 |
Last Update Date | 2023-10-03 |