| NPI | 1336196658 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NC 101205) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 101205) |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2008-07-08 |