| NPI | 1659364354 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 5509) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: AL PA399) |
| 363AS0400X Physician Assistant Surgical (Licence: GA 005509) | |
| 363AS0400X Physician Assistant Surgical (Licence: FL PA9112688) | |
| Enumeration Date | 2005-08-26 |
| Last Update Date | 2020-08-24 |