| NPI | 1518010966 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WI 1289) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NM 2001-PA32) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2011-08-01 |