| NPI | 1407044027 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: FL 9110538) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9110538) |
| Enumeration Date | 2007-10-09 |
| Last Update Date | 2022-04-15 |