| NPI | 1760483697 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110002029) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 104177) |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2013-08-14 |