| NPI | 1215294020 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA0006102) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA07781) |
| 363A00000X Physician Assistant (Licence: PA MA056092) | |
| 363A00000X Physician Assistant (Licence: NJ 25MP00399900) | |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2024-11-15 |