| NPI | 1457439721 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110010395) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MA 2325) |
| 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-00244) | |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2025-03-17 |