| NPI | 1629322524 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-14405) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 01678) |
| Enumeration Date | 2012-10-31 |
| Last Update Date | 2026-05-28 |