| NPI | 1700158508 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: VA 0110003259) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110003759) |
| Enumeration Date | 2012-02-08 |
| Last Update Date | 2023-02-14 |