| NPI | 1164649471 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MO 2007003918) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2007003918) |
| 363AS0400X Physician Assistant, Surgical (Licence: AR PA-405) | |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2021-09-30 |