| NPI | 1255446548 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: WV 483) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: WV 01160) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2015-08-28 |