| NPI | 1649561408 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WV 01613) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: VT 0550031101) |
| Enumeration Date | 2011-04-28 |
| Last Update Date | 2022-04-15 |