| NPI | 1396974473 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110003038) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-05494) |
| Enumeration Date | 2009-07-09 |
| Last Update Date | 2024-06-20 |