| NPI | 1689895260 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA1750) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MA 1750) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2020-01-16 |