| NPI | 1518007301 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: PA MA051443) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: AZ 5203) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2020-08-10 |