| NPI | 1780808931 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-01988) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: SC 890) |
| 363AS0400X Physician Assistant, Surgical (Licence: MO 2024045093) | |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2024-11-22 |