| NPI | 1508981218 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 2111) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 01271) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2021-05-20 |