| NPI | 1699824631 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-00903) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110001852) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2021-03-09 |