| NPI | 1962885020 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110004997) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: VA 0110004997) |
| 363AS0400X Physician Assistant, Surgical (Licence: VA 0110004997) | |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2017-05-02 |