| NPI | 1629551668 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OR 196149) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NH 1404) |
| Enumeration Date | 2018-09-14 |
| Last Update Date | 2020-03-03 |