| NPI | 1063827194 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110004103) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-06421) |
| 363AM0700X Physician Assistant, Medical (Licence: NC 0010-06421) | |
| 363AM0700X Physician Assistant, Medical (Licence: VA 0110004103) | |
| Enumeration Date | 2014-06-27 |
| Last Update Date | 2025-08-26 |