| NPI | 1770764789 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: VA 0110002632) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TN 1625) |
| Enumeration Date | 2007-11-19 |
| Last Update Date | 2017-02-06 |