| NPI | 1790108165 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-04671) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110-004456) |
| Enumeration Date | 2014-01-21 |
| Last Update Date | 2024-03-25 |