| NPI | 1811943780 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110840426) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: VA 0110840426) |
| 363AM0700X Physician Assistant Medical (Licence: MS PA078) | |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2023-03-07 |