| NPI | 1053482950 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: VA 0110003282) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CT 001705) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2015-01-19 |