| NPI | 1063487890 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-00759) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DE c5-0000456) |
| 363A00000X Physician Assistant (Licence: VA 0110001887) | |
| 363A00000X Physician Assistant (Licence: MD C0002942) | |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2022-10-20 |