| NPI | 1528548195 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA059823) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WV 2266) |
| Enumeration Date | 2018-08-14 |
| Last Update Date | 2021-08-13 |