| NPI | 1255351540 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110001256) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0110001256) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0110001256) | |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2021-08-02 |