| NPI | 1104979004 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA052780) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110009083) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2023-03-28 |