| NPI | 1013029453 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AL TA1611) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: AL TA1611) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2007-07-08 |