| NPI | 1104209691 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 2381) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: SC 2381) |
| Enumeration Date | 2015-07-02 |
| Last Update Date | 2021-06-10 |