| NPI | 1649272410 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WV WV1617) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10000517A) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2023-01-25 |