| NPI | 1730476201 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-09078) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110003610) |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2022-04-28 |