| NPI | 1184674749 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 1089) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: GA 4212) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2012-11-15 |