| NPI | 1821739764 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA102170) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: RI PA01499) |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2026-01-21 |