| NPI | 1790505246 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WV 3054) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MA066139) |
| Enumeration Date | 2024-10-10 |
| Last Update Date | 2025-03-21 |