| NPI | 1780184143 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA6437) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: RI PA01120) |
| 363AS0400X Physician Assistant, Surgical (Licence: MA PA6437) | |
| 363AM0700X Physician Assistant, Medical (Licence: MA PA6437) | |
| Enumeration Date | 2018-02-12 |
| Last Update Date | 2022-02-11 |