| NPI | 1679825004 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AZ 5299) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 5299) |
| 363AM0700X Physician Assistant, Medical (Licence: AZ 5299) | |
| Enumeration Date | 2012-10-09 |
| Last Update Date | 2024-11-12 |