| NPI | 1972796399 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-05017) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0003570) |
| 363A00000X Physician Assistant (Licence: VA 0110006185) | |
| Enumeration Date | 2007-08-20 |
| Last Update Date | 2021-05-13 |