| NPI | 1619249950 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110004520) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C05299) |
| Enumeration Date | 2012-02-02 |
| Last Update Date | 2014-06-02 |