| NPI | 1679919526 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110-004179) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: HI AMD1464) |
| Enumeration Date | 2013-05-20 |
| Last Update Date | 2025-07-22 |