| NPI | 1386752186 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MT 620) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: GA 004673) |
| 363AS0400X Physician Assistant, Surgical (Licence: MT 620) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2023-01-20 |