| NPI | 1811231210 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: RI PA01004) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: CT 002795) |
| Enumeration Date | 2012-11-26 |
| Last Update Date | 2018-08-20 |