| NPI | 1093145880 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110005408) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 017129) |
| 363A00000X Physician Assistant (Licence: WV 2051) | |
| 363A00000X Physician Assistant (Licence: WY PA870) | |
| Enumeration Date | 2013-11-15 |
| Last Update Date | 2022-02-03 |