| NPI | 1821252966 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA015427) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WV 01462) |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2023-01-10 |