| NPI | 1083924617 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 1534) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NE 1534) |
| 363AS0400X Physician Assistant Surgical (Licence: NE 1534) | |
| Enumeration Date | 2010-10-18 |
| Last Update Date | 2023-08-16 |