| NPI | 1912281213 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: RI PA00964) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: MA PA4238) |
| Enumeration Date | 2011-10-05 |
| Last Update Date | 2018-05-21 |