| NPI | 1659711679 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WV 2575) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA MA056192) |
| Enumeration Date | 2013-07-05 |
| Last Update Date | 2022-02-02 |