| NPI | 1619306420 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WV 01778) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-04351) |
| Enumeration Date | 2013-11-02 |
| Last Update Date | 2023-03-07 |