| NPI | 1922494632 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110005503) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MD C05752) |
| 363AS0400X Physician Assistant, Surgical (Licence: MD C05752) | |
| Enumeration Date | 2015-04-09 |
| Last Update Date | 2022-11-10 |