| NPI | 1720502230 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 2074) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 2074) |
| Enumeration Date | 2017-07-27 |
| Last Update Date | 2021-02-12 |