| NPI | 1619901568 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 102370) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: SC 1328) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2024-04-18 |