| NPI | 1912994575 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 001772) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: RI PA00340) |
| 363A00000X Physician Assistant (Licence: ME PA001240) | |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2014-05-22 |