| NPI | 1801147525 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA055612) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA OA002903) |
| Enumeration Date | 2012-09-20 |
| Last Update Date | 2021-05-05 |