| NPI | 1003317256 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110006133) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: VA 0110006133) |
| Enumeration Date | 2018-02-23 |
| Last Update Date | 2023-08-01 |