| NPI | 1104044924 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110006784) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NE 1260) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2020-01-15 |