| NPI | 1790781631 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 001007703) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110001691) |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2018-03-17 |