| NPI | 1730485384 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110003522) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC TL1887) |
| 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-05938) | |
| Enumeration Date | 2011-01-31 |
| Last Update Date | 2021-02-25 |