| NPI | 1225389604 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 5290) |
| 363AM0700X Physician Assistant, Medical (Licence: AZ 5290) | |
| 363AS0400X Physician Assistant, Surgical (Licence: AZ 5290) | |
| Enumeration Date | 2012-09-26 |
| Last Update Date | 2021-05-07 |