| NPI | 1013951888 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA055692) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: VA 0110002928) |
| 363A00000X Physician Assistant (Licence: MA 1157) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2019-11-20 |