| NPI | 1487130977 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: TN 4526) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110-006263) |
| 363AM0700X Physician Assistant Medical (Licence: TN 4526) | |
| Enumeration Date | 2018-07-17 |
| Last Update Date | 2021-09-27 |