| NPI | 1356307664 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-05853) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-05853) |
| 363AS0400X Physician Assistant, Surgical (Licence: VA 0110001067) | |
| 363AS0400X Physician Assistant, Surgical (Licence: TN 0000000910) | |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2021-03-10 |