| NPI | 1386902344 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MT MED-PAC-LIC-126864) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MO 2012012829) |
| 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0003979) | |
| Enumeration Date | 2012-04-27 |
| Last Update Date | 2024-02-21 |