| NPI | 1790862076 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: SD 0983) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IA 001882) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2015-08-19 |