| NPI | 1194063842 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110-005687) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-03975) |
| 363A00000X Physician Assistant (Licence: SC TL1900) | |
| 363A00000X Physician Assistant (Licence: SC 1900) | |
| Enumeration Date | 2013-01-30 |
| Last Update Date | 2018-03-17 |