| NPI | 1568746139 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110011222) | 
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NM PA2013-0072) | 
| 363A00000X Physician Assistant (Licence: AZ 6672) | |
| 363A00000X Physician Assistant (Licence: KS 15-02485) | |
| 363A00000X Physician Assistant (Licence: IL 085-004036) | |
| Enumeration Date | 2011-09-30 | 
| Last Update Date | 2025-08-18 |