| NPI | 1730612219 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WV 2045) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9116727) |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2022-11-07 |