| NPI | 1528291762 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110008448) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 001005780) |
| 363AM0700X Physician Assistant, Medical (Licence: MD c04010) | |
| Enumeration Date | 2009-09-03 |
| Last Update Date | 2022-07-12 |