| NPI | 1902873565 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: VA 0110003284) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 103579) |
| 363AM0700X Physician Assistant, Medical (Licence: TN 1185) | |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2015-07-15 |