| NPI | 1710088612 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 011002217) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NY 004674) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2020-04-10 |