| NPI | 1689836306 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-04977) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: TN 2128) |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2020-10-26 |