| NPI | 1740534106 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WV 01681) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110004225) |
| Enumeration Date | 2012-11-06 |
| Last Update Date | 2013-05-06 |