| NPI | 1083314496 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: WV 0874T) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2023-03-06 |
| Last Update Date | 2023-07-28 |