| NPI | 1326565102 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA060530) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 2085) |
| Enumeration Date | 2017-08-23 |
| Last Update Date | 2024-02-08 |