| NPI | 1164528568 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA050955) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 00939) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2009-01-27 |