| NPI | 1215125729 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: MT MED-PAC-LIC-513) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MT 513) |
| Enumeration Date | 2007-10-09 |
| Last Update Date | 2021-12-16 |