| NPI | 1194788547 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110005314) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 102993) |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2019-03-15 |