| NPI | 1730417262 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110003117) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MD C0004211) |
| 363AM0700X Physician Assistant, Medical (Licence: NC 0010-05753) | |
| Enumeration Date | 2009-11-20 |
| Last Update Date | 2021-10-27 |