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 |