| NPI | 1104134063 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: SC 2058) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0004532) |
| Enumeration Date | 2010-09-14 |
| Last Update Date | 2020-04-09 |