| NPI | 1245293695 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: MO DA104296) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: TN 571) |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2020-06-16 |