| NPI | 1568673010 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NH 1133) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50002490) |
| 363AS0400X Physician Assistant Surgical (Licence: MI 5601004966) | |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2015-12-16 |