| NPI | 1760225874 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110010820) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 3004) |
| Enumeration Date | 2024-06-17 |
| Last Update Date | 2025-07-09 |