| NPI | 1619159175 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA056039) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CT 002029) |
| Enumeration Date | 2007-11-27 |
| Last Update Date | 2015-12-21 |