| NPI | 1265776306 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-03917) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NC 0010-03917) |
| 363AS0400X Physician Assistant Surgical (Licence: NC 0010-03917) | |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2023-02-02 |