| NPI | 1780835512 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MD C04938) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-01551) |
| 363AS0400X Physician Assistant, Surgical (Licence: VA 0110003539) | |
| Enumeration Date | 2008-10-10 |
| Last Update Date | 2021-12-08 |