| NPI | 1962985655 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: VA 0110-006320) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110-006320) |
| 363AS0400X Physician Assistant Surgical (Licence: VA 0110-006320) | |
| Enumeration Date | 2018-09-10 |
| Last Update Date | 2018-11-30 |