| NPI | 1285702464 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AZ 3580) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AZ 3580) |
| 363A00000X Physician Assistant (Licence: AZ 3580) | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2014-01-20 |