| NPI | 1740748474 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110008489) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-08800) |
| Enumeration Date | 2019-03-12 |
| Last Update Date | 2025-03-31 |