| NPI | 1063062115 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WV 2571) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AL 1529) |
| Enumeration Date | 2019-09-19 |
| Last Update Date | 2021-11-08 |