| NPI | 1871158501 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA063541) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110-006678) |
| Enumeration Date | 2019-05-08 |
| Last Update Date | 2022-06-28 |