| NPI | 1255697751 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA5604) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 5754) |
| 363AS0400X Physician Assistant, Surgical (Licence: CA PA22112) | |
| 363AS0400X Physician Assistant, Surgical (Licence: AZ 5754) | |
| Enumeration Date | 2012-04-09 |
| Last Update Date | 2023-08-10 |