| NPI | 1760751952 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WV 2589) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DC PA030799) |
| 363AM0700X Physician Assistant, Medical (Licence: DC PA030799) | |
| Enumeration Date | 2011-12-19 |
| Last Update Date | 2022-02-15 |