| NPI | 1932520061 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WV 1765) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA056381) |
| 363A00000X Physician Assistant (Licence: WV 01765) | |
| Enumeration Date | 2013-12-16 |
| Last Update Date | 2017-10-24 |