| NPI | 1982717484 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 103658) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 103658) |
| 363AM0700X Physician Assistant, Medical (Licence: WV 1973) | |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2025-08-13 |