| NPI | 1790746105 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: SD 0631) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IA 001430) |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2010-09-29 |