| NPI | 1518071950 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA052650) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C05399) |
| 363A00000X Physician Assistant (Licence: WV 2196) | |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2022-08-29 |