| NPI | 1689673089 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WV 2113) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 281) |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2018-03-17 |