| NPI | 1568493955 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA MT1670151) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA000294L) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2014-11-07 |