| NPI | 1184007916 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110006430) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-05804) |
| 363AM0700X Physician Assistant, Medical (Licence: NC 0010-05804) | |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2022-08-15 |