| NPI | 1659398014 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 102422) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: VA 0110001795) |
| 363AS0400X Physician Assistant, Surgical (Licence: VA 0110001795) | |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2014-05-20 |