| NPI | 1104824358 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WV 1106) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110001519) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2008-03-10 |