| NPI | 1790999423 |
|---|---|
| Former Name | VIRGINIA BROACH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL 9104277) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AL PA.165) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2011-03-15 |