| NPI | 1174808059 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: DC PA030791) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 9863) |
| Enumeration Date | 2011-10-11 |
| Last Update Date | 2024-01-11 |