| NPI | 1124301312 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 001009611) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 01586) |
| Enumeration Date | 2011-09-23 |
| Last Update Date | 2024-05-01 |