| NPI | 1477891091 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110006357) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-04034) |
| Enumeration Date | 2013-01-17 |
| Last Update Date | 2025-05-06 |