| NPI | 1700245388 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: TN 3943T) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 3943) |
| 363AS0400X Physician Assistant Surgical (Licence: MT MED-PAC-LIC-44727) | |
| Enumeration Date | 2016-02-11 |
| Last Update Date | 2022-03-02 |