| NPI | 1124223664 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: DC PA030549) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: MD C03862) |
| 363A00000X Physician Assistant (Licence: NY 010641) | |
| 363AS0400X Physician Assistant Surgical (Licence: FL PA 9104241) | |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2022-12-16 |