| NPI | 1740657568 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: SD 1014) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IA 079660) |
| Enumeration Date | 2015-08-27 |
| Last Update Date | 2020-11-04 |