| NPI | 1013498682 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110006097) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 2231) |
| Enumeration Date | 2018-08-22 |
| Last Update Date | 2021-02-25 |