| NPI | 1821761974 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110010401) |
| Additional Taxonomies | 103T00000X Psychologist |
| 363AS0400X Physician Assistant, Surgical (Licence: VA 0110010401) | |
| Enumeration Date | 2021-07-26 |
| Last Update Date | 2026-06-18 |