| NPI | 1578597811 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: GA 006689) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 2019-023) |
| 363AM0700X Physician Assistant Medical (Licence: WI 2019-023) | |
| 363AS0400X Physician Assistant Surgical (Licence: WI 2019-023) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2013-02-20 |