| NPI | 1770954901 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-05947) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-05947) |
| Enumeration Date | 2015-10-14 |
| Last Update Date | 2015-11-12 |