| NPI | 1013641570 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WV 2624) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2022-07-12 |
| Last Update Date | 2023-11-28 |