| NPI | 1194807651 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-03356) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 01237) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2012-03-23 |