| NPI | 1164469896 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: VA 0110002304) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110002304) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2014-06-23 |