| NPI | 1760557920 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 100809) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110006584) |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2019-06-27 |