| NPI | 1215057799 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: PA MA053507) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: MD C0003589) |
| 363A00000X Physician Assistant (Licence: VA 0110002349) | |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2010-05-06 |