| NPI | 1124460308 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WV 01796) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA056230) |
| Enumeration Date | 2013-07-29 |
| Last Update Date | 2021-09-14 |