| NPI | 1861724130 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA4902) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: RI PA00543) |
| Enumeration Date | 2010-02-11 |
| Last Update Date | 2014-02-21 |