| NPI | 1639735996 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110007020) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-12396) |
| Enumeration Date | 2019-05-13 |
| Last Update Date | 2024-11-13 |