| NPI | 1376293605 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 4553) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 2617) |
| Enumeration Date | 2022-03-28 |
| Last Update Date | 2023-04-03 |