| NPI | 1184626806 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-02443) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA MA051965) |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2011-03-21 |