| NPI | 1902590193 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: RI PA01667) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA100321) |
| Enumeration Date | 2023-06-08 |
| Last Update Date | 2024-06-12 |