| NPI | 1780059204 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-12218) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: VA 0110-005152) |
| 363AS0400X Physician Assistant, Surgical (Licence: SC 4390) | |
| Enumeration Date | 2015-12-09 |
| Last Update Date | 2024-03-21 |