| NPI | 1629404207 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MD C05196) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA168081) |
| 363A00000X Physician Assistant | |
| 363AM0700X Physician Assistant, Medical (Licence: MD C05196) | |
| Enumeration Date | 2013-09-16 |
| Last Update Date | 2022-10-19 |