| NPI | 1740243641 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SD 0761) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MN 9835) |
| 363AS0400X Physician Assistant, Surgical (Licence: IA 001531) | |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2022-12-30 |