| NPI | 1336658459 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110005983) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-13089) |
| 363A00000X Physician Assistant (Licence: TN 4024) | |
| Enumeration Date | 2017-09-20 |
| Last Update Date | 2023-05-13 |