| NPI | 1568633824 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: SC 3053) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 001002076) |
| 363AS0400X Physician Assistant, Surgical (Licence: GA 5274) | |
| Enumeration Date | 2008-03-14 |
| Last Update Date | 2024-04-18 |