| NPI | 1053909762 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C009164) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 2448) |
| Enumeration Date | 2021-01-07 |
| Last Update Date | 2024-01-09 |