| NPI | 1750770582 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2019014624) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OK 2463) |
| Enumeration Date | 2015-01-16 |
| Last Update Date | 2019-07-05 |