| NPI | 1770642688 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA 2083) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601003110) |
| 363A00000X Physician Assistant (Licence: RI PA00392) | |
| 363A00000X Physician Assistant (Licence: NY 006856-1) | |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2012-01-13 |