| NPI | 1427158914 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA 1994) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MN 12766) |
| 363AS0400X Physician Assistant, Surgical (Licence: MA 1994) | |
| Enumeration Date | 2006-09-24 |
| Last Update Date | 2022-07-18 |