| NPI | 1740706803 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110008971) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 021192) |
| 363A00000X Physician Assistant (Licence: NC 0010-08005) | |
| Enumeration Date | 2017-08-20 |
| Last Update Date | 2023-08-08 |