| NPI | 1881920205 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA3893) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: RI PA00664) |
| Enumeration Date | 2009-10-20 |
| Last Update Date | 2020-11-20 |