| NPI | 1760961494 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: MD C0006902) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: DC PA031468) |
| Enumeration Date | 2018-08-13 |
| Last Update Date | 2018-08-13 |