| NPI | 1588060412 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-05219) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-05219) |
| 363L00000X Nurse Practitioner (Licence: NC 0010-05219) | |
| Enumeration Date | 2014-11-04 |
| Last Update Date | 2024-08-08 |