| NPI | 1710017223 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 1432) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IA 001792) |
| 363AS0400X Physician Assistant, Surgical (Licence: MN 10242) | |
| 363AS0400X Physician Assistant, Surgical (Licence: NE 1432) | |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2017-02-28 |