| NPI | 1164498416 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-02578) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: FL PA0003381) |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2022-01-10 |