| NPI | 1154655777 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: MT 31214) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MT 31214) |
| Enumeration Date | 2009-09-29 |
| Last Update Date | 2019-02-01 |