| NPI | 1336564640 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA OA004117) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA056554) |
| 363A00000X Physician Assistant (Licence: WV 741) | |
| Enumeration Date | 2014-02-24 |
| Last Update Date | 2021-09-15 |