| NPI | 1023358348 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110004173) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: VA 0110-004173) |
| 363AS0400X Physician Assistant, Surgical (Licence: WY PA626) | |
| Enumeration Date | 2013-02-22 |
| Last Update Date | 2020-09-24 |