| NPI | 1740511138 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: KS 15-01528) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MO 2010002162) |
| Enumeration Date | 2010-01-25 |
| Last Update Date | 2013-02-13 |