| NPI | 1164829222 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WV 01860) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2014-12-04 |
| Last Update Date | 2020-01-27 |