| NPI | 1609813930 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: DC 0110004232) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA 1174) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2020-01-16 |