| NPI | 1750368601 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110006437) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA050800) |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2021-06-23 |