| NPI | 1174922645 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: DC PA031071) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110-004698) |
| 363AM0700X Physician Assistant Medical (Licence: MD C0005474) | |
| Enumeration Date | 2014-08-20 |
| Last Update Date | 2019-05-17 |