| NPI | 1316044266 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA 1463) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC TL2930) |
| 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-01206) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2019-03-07 |