| NPI | 1104907245 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110002261) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-06425) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2022-05-23 |