| NPI | 1588947097 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WV 01531) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WV 630) |
| Enumeration Date | 2011-09-21 |
| Last Update Date | 2014-01-08 |