| NPI | 1811153463 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0002507) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 1949) |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2022-09-01 |