| NPI | 1639654759 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 2282) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NE 2282) |
| Enumeration Date | 2018-09-25 |
| Last Update Date | 2019-12-13 |