| NPI | 1053062984 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WV 2771) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.008227RX) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: WV 2771) | |
| Enumeration Date | 2022-01-12 |
| Last Update Date | 2023-10-03 |