| NPI | 1710416763 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA9007) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: RI PA00976) |
| 363A00000X Physician Assistant (Licence: WA PA61143693) | |
| 363A00000X Physician Assistant (Licence: CA PA56272) | |
| Enumeration Date | 2017-06-05 |
| Last Update Date | 2023-04-27 |