| NPI | 1003068867 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO 2812) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-01516) |
| 363AS0400X Physician Assistant, Surgical (Licence: CO 2812) | |
| Enumeration Date | 2008-10-10 |
| Last Update Date | 2012-01-20 |