| NPI | 1144301458 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MS PA00156) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AL PA-519) |
| 363AS0400X Physician Assistant, Surgical (Licence: LA 200067) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2018-05-09 |