| NPI | 1629717665 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110009969) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: DC PA200001493) |
| Enumeration Date | 2022-05-28 |
| Last Update Date | 2024-05-28 |