| NPI | 1407281538 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WV 01760) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AL 1825) |
| Enumeration Date | 2013-09-09 |
| Last Update Date | 2021-10-01 |