| NPI | 1265853428 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110004356) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DC PA030996) |
| 363AM0700X Physician Assistant, Medical (Licence: VA 0110004356) | |
| Enumeration Date | 2013-12-13 |
| Last Update Date | 2021-07-19 |