| NPI | 1215583869 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: WV 2442) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 2442) |
| Enumeration Date | 2019-08-09 |
| Last Update Date | 2022-11-10 |