| NPI | 1346522612 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 001001970) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA055129) |
| 363A00000X Physician Assistant (Licence: WV 1976) | |
| Enumeration Date | 2011-09-13 |
| Last Update Date | 2023-10-11 |