| NPI | 1104583947 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110008245) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0008268) |
| Enumeration Date | 2021-11-28 |
| Last Update Date | 2023-03-09 |