| NPI | 1417275629 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: MD C0004242) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110003244) |
| 363AS0400X Physician Assistant Surgical (Licence: DC PA030700) | |
| Enumeration Date | 2010-05-12 |
| Last Update Date | 2012-01-13 |