| NPI | 1184704298 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WV 1198) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110002249) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2007-07-08 |