| NPI | 1366585952 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110005572) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: DC PA030335) |
| 363AS0400X Physician Assistant, Surgical (Licence: VA 0110005572) | |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2021-12-03 |