| NPI | 1417930124 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 103517) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: NC 103517) |
| Enumeration Date | 2005-11-28 |
| Last Update Date | 2013-06-21 |