| NPI | 1265461313 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA053304) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: VA 0110001961) |
| 363AM0700X Physician Assistant, Medical (Licence: VA 0110001961) | |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2011-05-10 |