| NPI | 1821052218 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110003126) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 610) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2014-05-05 |