| NPI | 1588879142 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110002601) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-00749) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2020-10-07 |