| NPI | 1114206471 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: PA MA063445) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: PA OA002703) |
| 363AS0400X Physician Assistant Surgical (Licence: PA OA002703) | |
| Enumeration Date | 2011-08-04 |
| Last Update Date | 2022-03-16 |