| NPI | 1851694202 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110009103) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-10948) |
| 363AM0700X Physician Assistant, Medical (Licence: WA PA60188446) | |
| Enumeration Date | 2010-12-07 |
| Last Update Date | 2023-03-06 |