| NPI | 1023073608 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WV 01124) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110002473) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2012-04-11 |