| NPI | 1215418207 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: AZ 7475) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY TC739) |
| Enumeration Date | 2018-08-27 |
| Last Update Date | 2019-08-20 |