| NPI | 1225485279 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA058152) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 1974) |
| Enumeration Date | 2016-05-19 |
| Last Update Date | 2025-06-04 |