| NPI | 1598593741 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA065825) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 2875) |
| Enumeration Date | 2024-07-22 |
| Last Update Date | 2024-09-22 |