| NPI | 1790019149 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WV 01424) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-04100) |
| Enumeration Date | 2009-10-01 |
| Last Update Date | 2023-10-11 |