| NPI | 1376591008 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MO 2007013182) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TN 780) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2009-06-11 |