| NPI | 1568551729 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-01518) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 1782) |
| 363AS0400X Physician Assistant Surgical (Licence: NC 0010-01518) | |
| 363AS0400X Physician Assistant Surgical (Licence: GA 3097) | |
| 363AS0400X Physician Assistant Surgical (Licence: SC TL1782) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2021-12-22 |