| NPI | 1366874042 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-05336) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA056235) |
| Enumeration Date | 2013-08-05 |
| Last Update Date | 2022-01-12 |