| NPI | 1194796508 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: VA 0110006120) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: WV 319) |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2018-03-12 |