| NPI | 1487979852 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110003225) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
| 363AS0400X Physician Assistant, Surgical (Licence: SC TL2533) | |
| 363AS0400X Physician Assistant, Surgical (Licence: SC 2533) | |
| Enumeration Date | 2010-03-29 |
| Last Update Date | 2019-07-25 |