| NPI | 1780924795 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110004236) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-05193) |
| Enumeration Date | 2013-02-28 |
| Last Update Date | 2022-11-23 |