| NPI | 1376870394 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110004929) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 013679-1) |
| 363AM0700X Physician Assistant Medical (Licence: VA 0110004929) | |
| Enumeration Date | 2009-11-12 |
| Last Update Date | 2024-03-14 |