| NPI | 1760633382 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA 64265) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OH 50.003762) |
| 363AS0400X Physician Assistant, Surgical (Licence: VA 0110002884) | |
| Enumeration Date | 2008-10-01 |
| Last Update Date | 2024-05-22 |