| NPI | 1124423231 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110005378) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: VA 0110-005378) |
| Enumeration Date | 2014-10-31 |
| Last Update Date | 2023-12-15 |