| NPI | 1144253394 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110001533) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 277) |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2011-06-08 |