| NPI | 1235199571 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: IA 001076) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 1076) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2020-06-19 |