| NPI | 1740603463 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: RI PA01005) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA MA056279) |
| Enumeration Date | 2014-01-31 |
| Last Update Date | 2018-03-17 |