| NPI | 1295089357 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MA PA6151) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WA PA60410091) |
| 363AS0400X Physician Assistant, Surgical (Licence: CT 2847) | |
| Enumeration Date | 2012-10-28 |
| Last Update Date | 2020-12-15 |