| NPI | 1649565797 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 010004315) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 2014) |
| Enumeration Date | 2011-06-16 |
| Last Update Date | 2024-05-23 |