| NPI | 1184694713 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: TN 1697) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: MI MN001411) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2009-02-09 |