| NPI | 1518230499 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IL 085005565) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 5060) |
| 363A00000X Physician Assistant (Licence: CO 3353) | |
| Enumeration Date | 2012-02-22 |
| Last Update Date | 2015-09-25 |