| NPI | 1710352695 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA058159) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110-005153) |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2015-12-03 |
| Last Update Date | 2023-01-25 |