| NPI | 1366679979 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA07620) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00216600) |
| 363A00000X Physician Assistant (Licence: NY 013197) | |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2013-09-04 |