| NPI | 1215472436 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AR PA-697) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110008596) |
| 363A00000X Physician Assistant (Licence: GA 10083) | |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2016-12-23 |
| Last Update Date | 2024-02-01 |