| NPI | 1962037556 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110007395) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 9956) |
| 363A00000X Physician Assistant (Licence: CO PA.0006061) | |
| Enumeration Date | 2020-03-04 |
| Last Update Date | 2021-03-23 |