| NPI | 1205374337 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110008441) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-06901) |
| Enumeration Date | 2017-02-09 |
| Last Update Date | 2022-05-23 |