| NPI | 1033472220 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MT MED-PAC-LIC-32693) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MT 32693) |
| 363AS0400X Physician Assistant, Surgical (Licence: OR 156936) | |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2018-10-16 |