| NPI | 1154379311 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: PA MA054807) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA054807) |
| 363AS0400X Physician Assistant, Surgical (Licence: CT 001714) | |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2020-10-13 |