| NPI | 1558471979 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110009837) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA MA051604) |
| 363A00000X Physician Assistant (Licence: MD C03721) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2024-05-10 |