| NPI | 1770987307 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WI 4326) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA172335) |
| 363A00000X Physician Assistant (Licence: IL 085.005231) | |
| Enumeration Date | 2014-10-10 |
| Last Update Date | 2021-06-21 |