| NPI | 1083040455 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-09034) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: RI PA01174) |
| 363AS0400X Physician Assistant, Surgical (Licence: SC 2827) | |
| Enumeration Date | 2013-09-17 |
| Last Update Date | 2023-06-08 |