| NPI | 1972585768 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110002720) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 02516) |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2023-02-21 |