| NPI | 1255684353 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-08229) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NC 0010-08229) |
| 363AS0400X Physician Assistant Surgical (Licence: DE C5-0000853) | |
| 363AS0400X Physician Assistant Surgical (Licence: PA MA056312) | |
| Enumeration Date | 2012-10-26 |
| Last Update Date | 2025-08-06 |