| 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 |