| NPI | 1619440559 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110008784) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-08906) |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2019-01-03 |
| Last Update Date | 2025-02-14 |