| NPI | 1053748780 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 001012112) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110004387) |
| Enumeration Date | 2013-09-26 |
| Last Update Date | 2022-04-21 |