| NPI | 1205253994 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MA PA4981) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA4981) |
| 363AS0400X Physician Assistant, Surgical (Licence: MA PA4981) | |
| Enumeration Date | 2014-03-20 |
| Last Update Date | 2018-04-10 |