| NPI | 1932497419 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: VA 0110004093) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 01560) |
| Enumeration Date | 2011-07-18 |
| Last Update Date | 2013-03-08 |