| NPI | 1184173734 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OR PA185197) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601007976) |
| 363A00000X Physician Assistant (Licence: IA 100660) | |
| Enumeration Date | 2016-09-23 |
| Last Update Date | 2022-03-02 |