| NPI | 1629620158 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA061468) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WV 2259) |
| Enumeration Date | 2019-07-15 |
| Last Update Date | 2025-10-07 |