| NPI | 1922638824 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110009864) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WV 2393) |
| Enumeration Date | 2020-01-19 |
| Last Update Date | 2024-08-16 |