| NPI | 1265076756 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WV 2313) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 2900) |
| 363AM0700X Physician Assistant, Medical (Licence: PA MA061004) | |
| Enumeration Date | 2019-10-29 |
| Last Update Date | 2022-10-28 |