| NPI | 1801128616 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: LA PA200535) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OR PA150304) |
| Enumeration Date | 2010-02-03 |
| Last Update Date | 2021-07-07 |