| NPI | 1609258979 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: WV 2282) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: WV 2282) |
| Enumeration Date | 2015-06-23 |
| Last Update Date | 2021-06-24 |