| NPI | 1790986875 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WV 00844) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 315) |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2008-11-13 |