| NPI | 1407805393 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MD C0006430) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110001473) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2019-09-04 |