| NPI | 1710963103 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WV 825) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 00825) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2020-12-04 |