| NPI | 1104065218 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0005386) |
| 363AS0400X Physician Assistant, Surgical (Licence: TX PA08433) | |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 013102) | |
| Enumeration Date | 2009-02-12 |
| Last Update Date | 2020-12-09 |