| NPI | 1790298511 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9113932) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA061462) |
| 363A00000X Physician Assistant (Licence: WV 2125) | |
| Enumeration Date | 2017-11-15 |
| Last Update Date | 2022-12-30 |