| NPI | 1093827636 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WV 258) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 00258) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2016-08-11 |