| NPI | 1396738357 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 117580) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 5231) |
| 363AS0400X Physician Assistant, Surgical (Licence: FL 9102253) | |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2020-02-26 |