| NPI | 1497196646 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110006726) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA056238) |
| Enumeration Date | 2013-07-16 |
| Last Update Date | 2019-07-18 |