| NPI | 1740275148 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: MD C02505) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0002505) |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2013-01-15 |