| NPI | 1750880522 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110010095) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-07892) |
| Enumeration Date | 2018-02-07 |
| Last Update Date | 2024-07-18 |