| NPI | 1740287119 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IN 10003396A) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MN 9948) |
| 363AS0400X Physician Assistant, Surgical (Licence: WV 1612-023) | |
| 363AS0400X Physician Assistant, Surgical (Licence: TX PA04880) | |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2023-01-11 |