| NPI | 1508174343 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: SC 1755) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: GA 005910) |
| Enumeration Date | 2010-09-15 |
| Last Update Date | 2021-08-25 |