| NPI | 1861402315 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA1870) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD 184767) |
| 363A00000X Physician Assistant (Licence: RI PA00738) | |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2014-12-03 |