| NPI | 1013623537 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WV 860) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0009401) |
| Enumeration Date | 2023-01-27 |
| Last Update Date | 2024-10-08 |