| NPI | 1235225095 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA054312) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA MA054312) |
| 363A00000X Physician Assistant (Licence: WV 01018) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2021-12-15 |