| NPI | 1104139153 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: PA MA054370) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: PA MA054370) |
| Enumeration Date | 2010-07-20 |
| Last Update Date | 2013-08-16 |