| NPI | 1588919591 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WV 2174) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C05705) |
| Enumeration Date | 2012-07-16 |
| Last Update Date | 2020-07-13 |