| NPI | 1679759781 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110002539) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-04386) |
| Enumeration Date | 2008-01-18 |
| Last Update Date | 2022-04-11 |