NPI | 1174684799 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: VA 0110003878) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 334) |
Enumeration Date | 2006-12-13 |
Last Update Date | 2013-03-29 |