| NPI | 1558768846 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: PA MA058811) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: AZ 5903) |
| Enumeration Date | 2014-12-02 |
| Last Update Date | 2017-02-01 |