| NPI | 1720586993 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110008585) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-07848) |
| Enumeration Date | 2018-01-23 |
| Last Update Date | 2022-06-20 |