| NPI | 1336668201 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: NC 0010-07536) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 9213) |
| Enumeration Date | 2017-09-12 |
| Last Update Date | 2019-05-22 |