| NPI | 1396731345 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MA PA102905) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA102905) |
| 363A00000X Physician Assistant (Licence: PA MA003538L) | |
| 363AM0700X Physician Assistant, Medical (Licence: PA MA003538L) | |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2026-08-11 |