| NPI | 1457429003 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 1442) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: VA 0110002447) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2012-11-19 |