| NPI | 1619123494 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WV 01371) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-07834) |
| Enumeration Date | 2008-08-13 |
| Last Update Date | 2018-02-22 |