| NPI | 1972877470 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-04513) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110003799) |
| Enumeration Date | 2012-03-01 |
| Last Update Date | 2014-01-16 |