| NPI | 1598079196 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WI 2560-23) | 
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WI 2560-23) | 
| Enumeration Date | 2010-08-06 | 
| Last Update Date | 2021-01-14 |