| NPI | 1528462058 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TN 4310) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 4310) |
| 363A00000X Physician Assistant (Licence: PA MA057212) | |
| 363AS0400X Physician Assistant, Surgical (Licence: PA MA057212) | |
| Enumeration Date | 2014-10-13 |
| Last Update Date | 2022-03-31 |