| NPI | 1174876387 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WV 01712) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WV 124) |
| Enumeration Date | 2012-10-25 |
| Last Update Date | 2013-07-23 |