| NPI | 1174519086 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: VA 0110004433) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA MA051911) |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2014-09-30 |