| NPI | 1073757225 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MA AP2174) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MO 2011017515) |
| Enumeration Date | 2009-04-30 |
| Last Update Date | 2011-12-29 |